Female bladder neck incision

Bladder neck resection or incision in the female is not a new urologic procedure; however, it has not been widely accepted because of poor results and complications. From January to December, 1986, ten such operations have been performed on females with obstructive uropathy. All had previous anti-incontinence procedures and postoperative obstruction developed. Bladder neck incisions rather than resections have been performed with encouraging results. Urologic presentation, urodynamic investigations, and details of the surgery are presented. Bladder neck incision is a valuable adjunct in the management of bladder neck obstruction in the female.     

Unilateral bladder neck incision: endoscopic treatment of bladder neck obstruction. Results in 100 patients

Endoscopic diathermy unilateral incision of the bladder neck was carried out in 100 consecutive male patients. This procedure was performed for bladder neck obstruction and small benign prostate. The operative details of this technique are given. Follow-up after 2 months revealed excellent symptomatic and urodynamic results. Morbidity was low. Results remain stable after 13 +/- 9 months. One patient needed a transurethral resection of the prostate. Retrograde ejaculation occurred in 5% of the patients. Unilateral bladder neck incision is a simple procedure safe, and easy to learn, with a low risk of retrograde ejaculation. It is the operation of choice for small benign prostate, bladder neck obstruction and young patients.     

女性原发性膀胱颈梗阻

目的 探讨女性原发性膀胱颈梗阻（ＰＢＮＯ）的临床及尿动力学特点。方法 回顾性分析６１例ＰＢＮＯ及３２例压力性尿失禁患者尿动力学检查资料。结果 ＰＢＮＯ病人分为内括约肌痉挛症（ＩＳＳ）组及膀胱颈梗阻（ＢＮＯ）组,前者４１例,后者２０例,压力流率测定成功率ＩＳＳ组低于ＢＮＯ组及对照组（４９％,８０％,８１％）。ＩＳＳ组及ＢＮＯ组Ｌｉｎ－ＰＵＲＲ ＢＯＯ分级〉Ⅱ级者占９４％,对照组９９％为０～Ⅰ级。ＩＳＳ组及ＢＮＯ组与对照组比较差别有显著性意义的指标为膀胱颈开放逼尿肌压（ＰＶＢ）、ＡＧ数（ＰｄｅｔＱｍａｘ－２Ｑｍａｘ）、剩余尿量及最大尿道闭合压（ＭＵＣＰ）。结论 ＰＢＮＯ诊断的重要参数为Ｌｉｎ－ＰＵＲＲ分级、ＰＶＢ及ＡＧ数,改良苄胺唑啉ＵＰＰ试验是内括约肌功能性梗阻定性定位的良好指标。Ｌｉｎ－ＰＵＲＲ〉Ⅱ级可确定为梗     

经尿道针状电极膀胱颈内切开治疗膀胱颈挛缩

目的:探讨治疗膀胱颈挛缩的有效手术方法。方法:对17例膀胱颈挛缩患者行经尿道针状电极膀胱颈内切开术。结果:17例患者术后无明显残余尿,最大尿流率为12.3~27.2ml/s,主诉症状好转。结论:经尿道针状电极膀胱颈内切开治疗膀胱颈挛缩,疗效确切,术后不易复发。     

Asymptomatic bladder neck incompetence in nulliparous females

This study investigated 29 nulliparous women using the technique of transvaginal ultrasound to assess whether their bladder necks were open or closed at rest. The patients comprised 2 groups: 4 reported occasional episodes of stress incontinence, all of whom had closed bladder necks; the remaining 25 patients were totally asymptomatic. Overall a 21% incidence of an open bladder neck was recorded. It is likely that the true incidence of open bladder necks in young nulliparous women is higher than this, since none of these patients had troublesome stress incontinence. Since women with open bladder necks are more likely to develop stress incontinence if the integrity of the distal sphincter mechanism is compromised by neural damage, antenatal recognition of this problem should provide a contraindication to traumatic vaginal delivery and may in the future reduce the incidence of symptomatic stress incontinence in the population.     

Persistent retrograde ejaculation following incision of the bladder neck for functional bladder neck stenosis? Side effects of the Turner-Warwick bladder neck incision

Twenty patients, between 20 and 51 years of age suffering from bladder neck dysfunction, were treated by bladder neck incision as proposed by Turner-Warwick. Good results and only minor side-effects were noticed. There was no case of permanent retrograde ejaculation.     

The value of the Kurtzke Functional Systems Scales in predicting incomplete bladder emptying

STUDY DESIGN: A field study was conducted in 40 patients with multiple sclerosis (MS) by comparing their residual urine volumes with the Kurtzke Functional Systems Scales for pyramidal (PFS) or bladder functions (BFS). OBJECTIVES: To determine whether raised residual urine volumes necessitating intermittent self catheterisation can be predicted by the PFS or BFS. SETTING: Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals Trust, London, UK. METHODS: In 40 patients with MS, post micturition residual volumes were measured with ultrasound prior to any treatment of bladder dysfunction. The patients' symptoms were assessed using PFS and BFS. Correlation between PFS, BFS and post micturition residual volumes were calculated as were sensitivity and specificity of PFS and BFS in predicting incomplete bladder emptying with residuals above 100 ml. RESULTS: None of the patients with a PFS or BFS of 0 or 1 had a residual of more than 100 ml. There was a linear progression of maximal residuals with PFS and BFS. Correlation between PFS (BFS) and the post micturition residual volumes was 0.37 (0.71). CONCLUSION: Unless a patient with MS has a PFS or BFS of greater than 1 they are unlikely to have incomplete bladder emptying with post micturition residual volumes above 100 ml. With PFS of BFS greater than 1 measurement of the post voiding residual volume is mandatory.     

Long-term results of bladder neck incision in men

A retrospective cohort of 163 male patients having either uni- (UI) or bilateral incision (BI) of the bladder neck to relieve infravesical obstruction was reviewed. Short-term results were excellent with significant improvement of flow rates. 82% (UI) and 87% (BI) of the incised patients were satisfied. Long-term results were assessed by a life-table analysis. 17% (UI) and 12% (BI) of the patients needed a reoperation during the observation period of 6 years. It is concluded that bladder neck incision is a method with few complications and favourable long-term results.     

Long-term follow-up of unilateral bladder neck incision

Sixty-four patients who underwent unilateral bladder neck incision (BNI) between 1980 and 1983 were reviewed. In 53 cases the flow rates showed no significant change from immediate post-operative values. All patients were interviewed or completed a questionnaire which demonstrated that 87% were satisfied with the long-term outcome of surgery. The incidence of repeat bladder neck incision or transurethral resection of prostate (TURP) compared well with the incidence reported in other studies, as did the recorded incidence of retrograde ejaculation at 16%, although 52.5% of patients noted a reduction in the volume of ejaculate.     

Functional bladder neck obstruction. Results of endoscopic bladder neck incision in 131 consecutive patients

Endoscopic diathermy incision of the bladder neck was carried out as a routine procedure in 131 consecutive male patients with an established diagnosis of functional bladder neck obstruction. Follow-up after 3 months revealed excellent symptomatic and urodynamic results. Morbidity was low and the post-operative stay in hospital short (median 2 days). Patients must be informed of the risk of retrograde ejaculation associated with the procedure and objective evidence of the diagnosis is essential.     

Indication and value of bladder neck incision.

200 bladder neck incisions in 172 patients with mechanical or functional outlet obstruction of neurogenic and nonneurogenic etiology are reported. The incision was performed with an electric cautery needle at 5--7--12 o'clock. Parameters of success were, beside the subjective reports, residual urine, urinary flow and a sophisticated urodynamic study. 71% of the women and 76% of the men showed improvement or relief of symptoms. Retrograde ejaculation was observed in only 7% of the men; the rate of complications was 2.5%. Despite limited experience and the lack of long-term follow-up, this technique is recommended for routine use.     

经尿道电切治疗女性膀胱颈部梗阻28例

目的探讨经尿道电切治疗女性膀胱颈部梗阻的临床疗效。方法自1997年7月～2004年5月,采用经尿道电切的方法治疗女性膀胱颈部梗阻28例。结果术中无电切综合征、膀胱穿孔等发生。手术时间平均5min。术后1月复诊,25例残余尿消失,排尿有力,尿线粗。结论经尿道电汽化治疗女性膀胱颈部梗阻操作简便、安全,损伤小,效果确切。     

Management of intrinsic sphincter deficiency in adolescent females with normal bladder emptying function

PURPOSE: Intrinsic sphincter deficiency is rare in adolescent females with normal bladder emptying function. Information regarding the long-term outcome of therapy in this group of patients is sparse. We report our long-term experience with 3 adolescent females with intrinsic sphincter deficiency and normal bladder function who were treated with an artificial urinary sphincter. We critically reviewed the literature regarding experience with anti-incontinence surgery in adolescent females, not only regarding the outcome of the surgical technique, but also issues not usually considered in older adults, including the impact of physical development and future childbearing. MATERIALS AND METHODS: The charts of 3 adolescent females with intrinsic sphincter deficiency were reviewed. In addition, relevant peer reviewed articles were selected by a MEDLINE search. The results of the artificial urinary sphincter, pubovaginal sling and periurethral injection of bulking agents were reviewed. Long-term efficacy, the complication rate, impact of pregnancy and physical development were assessed. RESULTS: The 3 patients had an excellent long-term outcome with the artificial urinary sphincter, including 1 with 2 pregnancies that ended in a normal vaginal delivery. The literature showed that a good long-term outcome was consistently achieved with the artificial urinary sphincter. An equally good outcome was achieved with the pubovaginal sling but long-term data are lacking. While periurethral injection of a bulking agent provides good initial results, they do not appear to be durable. In addition, the artificial urinary sphincter does not appear to impact pregnancy or physical development negatively. CONCLUSION: Data support the artificial urinary sphincter and pubovaginal sling as effective therapies in adolescent females with intrinsic sphincter deficiency. However, long-term data on the pubovaginal sling are not available. When considering the impact on future childbearing and physical development, the artificial urinary sphincter is a favorable option.     

Transurethral incision of the bladder neck and prostate.

Between March 1983 and December 1988, 66 men 50 years old and older with symptomatic bladder outlet obstruction underwent transurethral incision of the bladder neck and prostate. Patients selected for incision had a small, clinically benign, prostate and peak urinary flow rate of less than 15 ml. per second. Preoperative and postoperative evaluation included symptom questionnaires and uroflowmetry. A single midline incision was made extending from the bladder neck to the verumontanum. Results were available in 64 of the 66 men who underwent the procedure with a mean followup of 2.24 years. Mean symptom scores decreased from 9.66 preoperatively to 4.59 postoperatively (p less than 0.001) and peak urinary flow rates increased from 7.4 to 14.7 ml. per second (p less than 0.0001). Antegrade ejaculation was preserved in 83.3% of the men who preoperatively had antegrade ejaculation. Subsequent transurethral resection of the prostate was required in 5 patients (7.6%). With a mean followup of greater than 2 years transurethral incision of the bladder neck and prostate was effective in treatment of bladder outlet obstruction caused by a small prostate while maintaining antegrade ejaculation in the majority of patients.     

Long-term assessment of 107 patients undergoing bladder neck incision

The notes of 134 consecutive patients undergoing bladder neck incision (BNI) were analysed retrospectively. Details of pre-operative symptoms and the short-term results of the operation were studied, as well as the need for reoperation. Long-term results of the operation were not available in 100 patients and a questionnaire was sent to them asking for details of their present symptoms. This produced results on the long-term follow-up of 107 patients with a mean follow-up of 31 months (range 18-48); 86% of patients showed an improvement in symptoms in the short term whilst 68% maintained a subjective improvement in symptoms in the long term. Further surgery was required in 18 patients (13%). Possible reasons for this are discussed.     

Transurethral incision of the prostate and bladder neck.

Transurethral incision of the prostate (TUIP) is compared to transurethral resection of the prostate (TURP) by reviewing nonrandomized, matched, and randomized studies. These studies indicate that incision of the prostate and bladder neck relieves outflow urinary obstruction, as does TURP. The incision is relatively easier to learn and perform, and requires shorter operative time compared to TURP. The incidence of retrograde ejaculation is lower after incision than after TURP--16% versus 63%, on average. Transurethral incision of the prostate has a potential for reduced costs due to reduced operative time, shortened hospital stay, and the potential for local anesthesia.